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目的:探讨熊去氧胆酸联合还原型谷胱甘肽治疗极低出生体重儿胃肠外营养相关性胆汁淤积症(PNAC)的疗效。方法:选取2012年1月~2013年11月在钦州市妇幼保健院临床诊断为PNAC的85例极低出生体重儿为研究对象,并随机分为治疗组(43例)和对照组(42例),治疗组口服熊去氧胆酸15~20 mg·kg-1·d-1,同时加用还原型谷胱甘肽0.2 g/d,对照组单纯口服熊去氧胆酸15~20 mg·kg-1·d-1,疗程21天。比较两组治疗前及治疗10天和20天后总胆汁酸(TBA)、血清总胆红素(TB)、直接胆红素(DB)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)和γ-谷氨酰转移酶(γ-GGT)水平。结果:两组患儿治疗10天和20天后TBA、TB、DB、ALT、AST、γ-GGT与治疗前差值的比较,除对照组治疗10天后TBA、TB、DB、γ-GGT及AST外,其余差异均有统计学意义(P<0.05);两组治疗10天和20天后与治疗前TBA、TB、DB、ALT、AST、γ-GGT标准差值比较,除对照组TBA和DB外,差异均有统计学意义(P<0.05)。结论:单用熊去氧胆酸治疗极低出生体重儿PNAC有一定的疗效,但与联合还原型谷胱甘肽治疗相比,后者更安全有效。
Objective: To investigate the effect of ursodeoxycholic acid combined with reduced glutathione (GSH) in the treatment of very low birth weight infants with parenteral nutrition-associated cholestasis (PNAC). Methods: A total of 85 very low birth weight infants clinically diagnosed as PNAC in Qinzhou Maternal and Child Health Hospital from January 2012 to November 2013 were selected and randomly divided into treatment group (43 cases) and control group (42 cases ), The treatment group oral ursodeoxycholic acid 15 ~ 20 mg · kg-1 · d-1, plus the use of reduced glutathione 0.2 g / d, the control group of oral ursodeoxycholic acid 15 ~ 20 mg · Kg-1 · d-1, treatment for 21 days. The levels of total bile acid (TBA), serum total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate Aminotransferase (AST) and γ-glutamyl transferase (γ-GGT) levels. Results: The difference of TBA, TB, DB, ALT, AST, γ-GGT and TBA, TB, DB, γ-GGT and AST before and after treatment for 10 days and 20 days in both groups were compared (P <0.05). Compared with the standard deviation of TBA, TB, DB, ALT, AST and γ-GGT in both groups after treatment for 10 days and 20 days, The differences were statistically significant (P <0.05). Conclusion: Ursodeoxycholic acid treatment of very low birth weight children with PNAC have a certain effect, but compared with the combination of reduced glutathione, the latter is more secure and effective.